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http://pdfs.journals.lww.com/jneuro-ophthalmology/1999/06000/Occurence_of_Familial_Nonarteritic_Anterior.55.pdf
Objective: To report on the occurrence of familial nonarteritic anterior ischemic optic neuropathy (NAION) in our NAION series.
Methods: One hundred forty-eight consecutive retrievable cases of NAION were surveyed regarding the occurrence of NAION in other family members. Medical records of affected family members were reviewed, and clinical characteristics of documented familial NAION cases were described.
Results: Of 79 patients who returned the survey, four reported one or more relatives with previously diagnosed NAION. There were nine cases of documented NAION in these four families. All cases occurred in siblings, with a mean age at onset of 55 years, Six patients had second eye involvement and in five, involvement became bilateral within 4 years after initial onset. None of the patients had diabetes; two had hypertension.
Conclusion: A small number of patients with NAION may belong to a familial subclass, Three previous reports of familial NAION further support this hypothesis.
(C) 1999 Lippincott Williams & Wilkins, Inc.]]>Wed, 08 Jun 2011 09:27:10 GMT-05:0000041327-199906000-00055http://pdfs.journals.lww.com/jneuro-ophthalmology/1994/03000/Incidence_of_Nonarteritic_and_Arteritic_Anterior.11.pdf
This population-based study was undertaken to obtain information on age-, sex-, and race-specific incidence of nonarteritic and arteritic anterior ischemic optic neuropathy for the State of Missouri and for Los Angeles County, California. Among subjects who were 50 or older the estimated mean annual incidence rates per 100,000 population were 2.30 for nonarteritic anterior ischemic optic neuropathy and 0.36 for arteritic anterior ischemic optic neuropathy. White individuals appear to be at significantly higher risk of developing nonarteritic anterior ischemic optic neuropathy than black or Hispanic individuals, suggesting possible genetic predisposition.
(C) Williams & Wilkins 1994. All Rights Reserved.]]>Wed, 08 Jun 2011 09:29:14 GMT-05:0000041327-199403000-00011http://pdfs.journals.lww.com/jneuro-ophthalmology/1995/03000/Pain_in_Anterior_Ischemic_Optic_Neuropathy_.2.pdf
Purpose: The diagnoses of both anterior ischemic optic neuropathy (AION) and optic neuritis are clinical ones with significant overlap of symptoms and signs. This study investigates the presence and character of pain at the onset of AION, in order to evaluate this symptom as a differentiating diagnostic feature between optic neuritis and AION.
Methods: Forty-one consecutive patients over 45 years of age with a clinical syndrome consistent with AION were questioned about the presence and character of associated pain.
Methods: Pain was reported by 12% (5 of 41) of the patients with AION. This is contrasted with data compiled on 448 patients enrolled in the optic neuritis treatment trial, of whom 92.2% complained of pain.
Methods: While there is overlap in the incidence and character of pain in AION and optic neuritis, its presence/absence remains a useful differentiating feature.
(C) Williams & Wilkins 1995. All Rights Reserved.]]>Wed, 08 Jun 2011 10:09:36 GMT-05:0000041327-199503000-00002http://pdfs.journals.lww.com/jneuro-ophthalmology/1998/09000/Anterior_Ischemic_Optic_Neuropathy_in_a_Disc_With.3.pdf
No abstract available]]>Wed, 08 Jun 2011 10:11:37 GMT-05:0000041327-199809000-00003http://journals.lww.com/jneuro-ophthalmology/Fulltext/2003/06000/Pathogenesis_of_Nonarteritic_Anterior_Ischemic.12.aspx
Based on histopathology, electron microscopic corrosion cast studies, optic nerve blood flow studies, and clinical data, the pathogenesis of idiopathic nonarteritic ischemic optic neuropathy includes the following features: (1) structurally crowded optic discs are predisposed; (2) laminar and retrolaminar regions are the most common locations for infarction; (3) there is flow impairment in the prelaminar optic disc during the acute phase; (4) lack of consistent choroidal flow impairment and the retrolaminar location of infarcts suggest vasculopathy within or distal to the paraoptic branches of the posterior choroidal arteries; (5) diabetes is the most consistently identified vasculopathic risk factor; (6) impaired autoregulation of the disc circulation by atherosclerosis, with a possible contribution from serotonin and endothelin-mediated vasospasm, may play a role; and (7) progression may be caused by secondary cell death after the initial ischemic insult or compression from cavernous degeneration and mechanical axonal distortion.
Nonarteritic anterior ischemic optic neuropathy (NAION) is presumed to result from circulatory insufficiency within the optic nerve head, but the specific mechanism and location of the vasculopathy remain unproven. In the arteritic form of AION (AAION), by contrast, histopathologic evidence confirms both inflammatory occlusion of short posterior ciliary arteries (SPCAs) and infarction within the optic nerve head. Much of the research regarding the etiology of NAION has centered on the SPCA and choroidal circulations and factors that might compromise them. Studies have included anatomic and physiologic (blood flow) analysis of the optic discs in NAION, along with attempts to link various vascular risk factors to affected subject populations. Several authorities have recently speculated as to the relative contributions of these interrelated elements (1–5). This review summarizes evidence for the roles of the following factors in the pathogenesis of idiopathic NAION, the form that is not associated with specific precipitating factors such as acute systemic hypotension or anemia: (1) Optic disc vasculopathy and infarction: histopathology and electron microscopic corrosion casting studies of optic disc circulation; (2) optic disc blood flow impairment: studies of optic nerve head and peripapillary choroidal blood flow, including fluorescein angiography, indocyanine green angiography (ICG), color Doppler flow (CDF) studies, and laser Doppler flow (LDF) studies; (3) risk factors for vascular occlusion: prevalence studies of vasculopathic and prothrombotic risk factors; and (4) other contributing factors: optic disc structure “crowding,” systemic nocturnal hypotension, vasospasm, impaired autoregulation, and secondary neuronal degeneration mechanisms.]]>Wed, 08 Jun 2011 10:17:49 GMT-05:0000041327-200306000-00012http://journals.lww.com/jneuro-ophthalmology/Fulltext/2005/03000/A_Comparison_of_Risk_Factors_for_Postoperative_and.6.aspx
Background: Whether postoperative non-arteritic ischemic optic neuropathy (NAION) is caused by surgery is unsettled. To provide further evidence on this issue, it is useful to compare the characteristics of patients who develop NAION following intraocular surgery to those who develop NAION spontaneously.
Methods: In a retrospective review of patients diagnosed with NAION between January 1, 1993 and December 31, 1999, 12 cases of NAION in 11 subjects were identified as occurring within 30 days of cataract extraction or intraocular lens exchange (postoperative NAION group). Using Fisher exact test, the prevalence of NAION risk factors (hypertension, diabetes mellitus, hypercholesterolemia, smoking, small cup-to-disc ratios) was compared with that of a similarly aged control group of 37 subjects diagnosed with spontaneous NAION (spontaneous NAION group).
Results: Patients with postoperative NAION had a lower prevalence of hypertension than did those with spontaneous NAION (27% versus 68%, P = 0.034) and a lower prevalence of cup-to-disc ratios of less than or equal to 0.2 (55% vs. 94%, P = 0.006). The prevalence of elevated cholesterol, diabetes mellitus, and tobacco use was similar in the two groups.
Conclusions: The prevalence of hypertension and low cup-to-disc ratios is significantly lower in subjects with NAION following lens-related intraocular surgery than in those with spontaneous NAION, indicating that risk factors for NAION in these settings may be different.]]>Wed, 08 Jun 2011 10:18:50 GMT-05:0000041327-200503000-00006http://pdfs.journals.lww.com/jneuro-ophthalmology/1997/09000/Anterior_Ischemic_Optic_Neuropathy_and_Activated.3.pdf
Nonarteritic anterior ischemic optic neuropathy (AION) is a well-described entity that is believed to be caused by abnormal anatomy of the optic disc and to be precipitated by several stressor-s or disease states. Activated protein C resistance (APCR) is a recently described mutation of factor V (FV) gene that renders FV resistant to cleavage by activated protein C. APCR predisposes to thrombotic events. The case of a 61-year-old woman with AION and activated protein C resistance is presented, and the management is discussed. We thoroughly review the literature on these two conditions. We propose that a prospective analysis of the potential role of APCR in some cases of AION is needed and suggest that physicians consider this and other prothombotic states when evaluating patients with AION.
(C) Williams & Wilkins 1997. All Rights Reserved.]]>Wed, 08 Jun 2011 10:19:31 GMT-05:0000041327-199709000-00003http://journals.lww.com/jneuro-ophthalmology/Fulltext/2004/09000/Bilateral_Anterior_Ischemic_Optic_Neuropathy_After.5.aspx
A 30-year-old woman had bilateral anterior ischemic optic neuropathy after undergoing large-volume liposuction. Visual function remained stable over a four-month follow-up, with decreased visual acuity and marked constriction of the visual fields. To our knowledge, this is the second reported case of ischemic optic neuropathy in this setting.]]>Wed, 08 Jun 2011 10:24:17 GMT-05:0000041327-200409000-00005http://journals.lww.com/jneuro-ophthalmology/Fulltext/2008/09000/Nonarteritic_Ischemic_Optic_Neuropathy_After_LASIK.22.aspx
No abstract available]]>Wed, 08 Jun 2011 10:25:41 GMT-05:0000041327-200809000-00022http://journals.lww.com/jneuro-ophthalmology/Fulltext/2009/06000/Anterior_Ischemic_Optic_Neuropathy_After.18.aspx
No abstract available]]>Wed, 08 Jun 2011 10:26:35 GMT-05:0000041327-200906000-00018http://journals.lww.com/jneuro-ophthalmology/Fulltext/2003/12000/Interferon___Associated_Bilateral_Simultaneous.3.aspx
The authors describe one patient with essential thrombocytosis and one with chronic hepatitis C infection who developed bilateral simultaneous anterior ischemic optic neuropathy within 3 months of starting treatment with interferon-α. One patient had several typical risk factors for conventional AION; the other did not. These cases are the fourth and fifth reported examples of this phenomenon. Interferon-α treatment may cause or aggravate the risk of developing anterior ischemic optic neuropathy. Vulnerable patients should be advised of this potential complication, assisted in reducing risk factors, and monitored for optic nerve and retinal vascular complications.
Anterior ischemic optic neuropathy (AION), a common cause of acute optic neuropathy in the elderly (1–3), is presumed to be a small infarct within the optic nerve head. Many patients have arteriosclerotic risk factors (3). We report two patients in whom bilateral AION occurred shortly after onset of treatment with interferon-α for essential thrombocytosis and hepatitis C.
Interferon-α is a natural glycoprotein produced and secreted by immune cells in response to viral infections, exerting its effects by binding to a membrane receptor and initiating intracellular signaling that ultimately leads to expression of specific genes. This leads to the enhancement and induction of target cell killing by lymphocytes and inhibition of virus replication in infected cells. Interferon-α has anticytokine, antiviral, immunomodulatory, and antiproliferative activities. It is used to treat cancer, chronic hepatitis C and B, and essential thrombocytosis (4).
Ophthalmologic complications are rare and include retinal vascular occlusions, retinal hemorrhages, and AION (5–7). Most reported cases of interferon-α retinopathy are asymptomatic. When treatment with interferon-α is discontinued, the retinopathy usually resolves. Diabetes, hypertension, and anemia are risk factors for the development of interferon-α retinopathy (3).
Anterior ischemic optic neuropathy is an uncommon complication of interferon-α treatment. Purvin (6) reported two cases of sequential AION and Lohmann (7) a single case. We describe two cases of AION occurring simultaneously in two eyes shortly after onset of treatment with interferon-α.]]>Wed, 08 Jun 2011 10:27:24 GMT-05:0000041327-200312000-00003http://journals.lww.com/jneuro-ophthalmology/Fulltext/2010/06000/Pegylated_Interferon_Alpha_Associated_Optic.2.aspx
A 52-year-old man with chronic hepatitis C presented with painless, bilateral, simultaneous nonarteritic anterior ischemic optic neuropathy (NAION) and peripheral neuropathy. Symptoms began 19 weeks after starting peginterferon alpha-2a. The peripheral neuropathy and vision of the right eye improved, but the vision of the left eye worsened after stopping interferon. We identified 23 additional cases of NAION during interferon alpha therapy. At least 12 of these patients suffered bilateral NAION. Patients lost vision 1-40 weeks after initiating therapy. Of 21 eyes that had documented initial and follow-up acuities, 8 improved, 1 worsened, and the rest remained stable. One patient had a painful peripheral neuropathy. Treatment with interferon alpha may result in NAION. Discontinuation of therapy deserves consideration after weighing individual risks and benefits.]]>Wed, 08 Jun 2011 10:28:09 GMT-05:0000041327-201006000-00002http://journals.lww.com/jneuro-ophthalmology/Fulltext/2005/12000/Erectile_Dysfunction_Drugs_and_Non_Arteritic.9.aspx
Abstract: The recent reports of non-arteritic anterior ischemic optic neuropathy (NAION) occurring shortly after ingestion of erectile dysfunction agents have raised the question of whether these agents have a cause-and-effect relationship to NAION. The nature of optic nerve head blood flow and the various factors that influence it, the systemic vascular effects of these agents, and the clinical features of NAION lead me to believe that these agents are contributory factors. Patients with the appropriate risk factors should, therefore, be warned of this possibility and advised to refrain from using these agents.]]>Wed, 08 Jun 2011 10:29:01 GMT-05:0000041327-200512000-00009http://journals.lww.com/jneuro-ophthalmology/Fulltext/2005/09000/Amiodarone_and_Optic_Neuropathy__The_Heart_of_the.17.aspx
Amiodarone is one of the most effective antiarrhythmic drugs currently available. Although a subject of intense controversy, a causal link between amiodarone and optic neuropathy has never been firmly established. Indications for treatment with amiodarone are outlined, and features of the optic neuropathy in patients on amiodarone are compared with those of nonarteritic anterior ischemic optic neuropathy. An approach to patients treated with amiodarone who present with optic neuropathy is outlined, and suggestions for a registry and prospective study of such patients are presented.]]>Wed, 08 Jun 2011 10:29:48 GMT-05:0000041327-200509000-00017http://journals.lww.com/jneuro-ophthalmology/Fulltext/2006/03000/Non_Arteritic_Anterior_Ischemic_Optic_Neuropathy,.1.aspx
No abstract available]]>Wed, 08 Jun 2011 10:30:23 GMT-05:0000041327-200603000-00001http://journals.lww.com/jneuro-ophthalmology/Fulltext/2006/06000/Amiodarone,_Erectile_Dysfunction_Drugs,_and.21.aspx
No abstract available]]>Wed, 08 Jun 2011 10:31:22 GMT-05:0000041327-200606000-00021http://journals.lww.com/jneuro-ophthalmology/Fulltext/2005/03000/Nonarteritic_Ischemic_Optic_Neuropathy_Developing.3.aspx
Seven patients, aged between 50 and 69 years, had typical features of nonarteritic anterior ischemic optic neuropathy (NAION) within 36 hours after ingestion of sildenafil citrate (Viagra) for erectile dysfunction. Six patients had vision loss within 24 hours after use of the agent. Final visual acuity in the affected eye ranged from 20/20 to light perception. Both eyes were affected in one individual. All affected individuals had pre-existing hypertension, diabetes, elevated cholesterol, or hyperlipidemia. Seven similar cases have been previously reported. Sildenafil may provoke NAION in individuals with an arteriosclerotic risk profile.]]>Wed, 08 Jun 2011 10:32:01 GMT-05:0000041327-200503000-00003http://journals.lww.com/jneuro-ophthalmology/Fulltext/2008/12000/Annual_Meeting_of_the_Association_for_Research_in.17.aspx
No abstract available]]>Wed, 08 Jun 2011 10:33:12 GMT-05:0000041327-200812000-00017http://journals.lww.com/jneuro-ophthalmology/Fulltext/2001/03000/Anterior_Ischemic_Optic_Neuropathy_Associated_With.6.aspx
A 42-year-old male presented with acute onset of an inferior visual field defect OD after sildenafil citrate use. Examination revealed a right relative afferent pupillary defect and a swollen disc with a 0.1 cup-to-disc ratio and a prominent disc hemorrhage.Anterior ischemic optic neuropathy (AION) is associated with acute episodes of hypotension in patients with structurally crowded discs. Sildenafil citrate may cause episodes of hypotension and was temporally related to the onset of symptoms in this patient. Because patients are often reluctant to volunteer their history of sildenafil citrate use, the physician may need to ask specifically about use of this medication. Physicians should counsel patients with crowded optic discs and a history of nonarteritic anterior ischemic optic neuropathy in one eye that use of sildenafil citrate might increase their risk of ischemic optic neuropathy in the fellow eye.]]>Wed, 08 Jun 2011 11:08:24 GMT-05:0000041327-200103000-00006http://journals.lww.com/jneuro-ophthalmology/Fulltext/2007/03000/Amiodarone_and_Ischemic_Optic_Neuropathy.27.aspx
No abstract available]]>Wed, 08 Jun 2011 11:09:54 GMT-05:0000041327-200703000-00027http://pdfs.journals.lww.com/jneuro-ophthalmology/1995/09000/Magnetic_Resonance_Imaging_of_the_Brain_in.6.pdf
We wished to determine whether the number of central nervous system (CNS) white matter lesions on magnetic resonance imaging (MRI) is increased in patients with nonarteritic ischemic optic neuropathy (NAION). T2-Weighted axial images of the brain in 13 patients with acute NAION and 16 age-matched controls were used to tabulate the number of subcortical and periventricular white matter lesions. Groups were compared by t test for means, the Wilcoxon-Mann-Whitney rank-sum test, and chi-square test for proportions with at least one lesion. The mean number of CNS white matter ischemic lesions in the NAION group was 4.0 (range 0-20) as compared to 1.4 (range 0-7) in the control group. The difference in these samples suggested a significant increase in NAION (p = 0.069, rank-sum test). The proportions of patients with at least one lesion were not significantly different (53.8% NAION vs. 56.3% controls). The data suggest an increased number of CNS white matter lesions in patients with NAION.
(C) Williams & Wilkins 1995. All Rights Reserved.]]>Wed, 08 Jun 2011 11:11:35 GMT-05:0000041327-199509000-00006http://pdfs.journals.lww.com/jneuro-ophthalmology/1997/12000/Aspirin_Reduces_the_Incidence_of_Second_Eye_NAION_.7.pdf
The objective of this study was to determine if aspirin reduces the incidence of second eye involvement after nonarteritic anterior ischemic optic neuropathy (NAION) in one eye. Records were reviewed of 131 patients who sustained unilateral NAION. Of these, the 33 patients who sustained second eye NAION were compared to those followed for a minimum of 2 years without sustaining a second eye NAION (67). Thirty-one of the 131 patients were excluded because of inadequate follow-up. Except for diabetes (relative risk [RR] 1.43, p = 0.05), the incidence of second eye NAION was independent of gender, age, cup/disk, hypertension, anemia, and migraine. The degree of visual acuity or field dysfunction in the first eye correlated poorly with the acuity (r = 0.28) and field (r =0.33) loss in the second eye. Aspirin (65-1,300 mg) taken two or more times per week decreased the incidence (17.5% vs. 53.5%) and relative risk (RR = 0.44, p = 0.0002) of second eye AION regardless of the usual risk factors. Even after eliminating those patients who had bilateral disease when first referred, ASA still reduced the incidence of second eye involvement (35% vs. 13%, RR = 0.74, p = 0.01). Aspirin may be an effective means of reducing second eye NAION.
(C) Williams & Wilkins 1997. All Rights Reserved.]]>Wed, 08 Jun 2011 11:13:03 GMT-05:0000041327-199712000-00007http://journals.lww.com/jneuro-ophthalmology/Fulltext/2010/06000/Should_Steroids_be_Offered_to_Patients_With.21.aspx
No abstract available]]>Wed, 08 Jun 2011 11:17:36 GMT-05:0000041327-201006000-00021http://journals.lww.com/jneuro-ophthalmology/Fulltext/2010/12000/Role_of_Steroid_Therapy_in_Nonarteritic_Anterior.18.aspx
No abstract available]]>Wed, 08 Jun 2011 11:18:50 GMT-05:0000041327-201012000-00018http://pdfs.journals.lww.com/jneuro-ophthalmology/1994/06000/Outcomes_of_Optic_Nerve_Sheath_Decompression_for.3.pdf
Efficacy of optic nerve sheath decompression (ONSD) in treating non-arteritic ischemic optic neuropathy (NAION) is not clear. We retrospectively analyzed the records of 91 patients with NAION, who were examined during a two-year period, and compared the final Snellen visual acuities of eyes treated with ONSD with those of eyes that did not have surgery. Seven of 18 eyes with ONSD (39%) demonstrated increased visual acuity of two or more lines; whereas 23 of 71 eyes without surgery (32%) had increased acuity. The ONSD group and no surgery group were further subdivided into eyes with progressive visual loss and nonprogressive visual loss. No statistically significant differences in visual outcome between groups were found. We did not find the high frequency of visual improvement that has been reported in some studies of ONSD for NAION.
(C) Williams & Wilkins 1994. All Rights Reserved.]]>Wed, 08 Jun 2011 11:19:43 GMT-05:0000041327-199406000-00003http://pdfs.journals.lww.com/jneuro-ophthalmology/1995/06000/Optic_Nerve_Sheath_Fenestration_for_Anterior.1.pdf
No abstract available]]>Wed, 08 Jun 2011 11:21:01 GMT-05:0000041327-199506000-00001http://journals.lww.com/jneuro-ophthalmology/Fulltext/2007/09000/Intravitreal_Triamcinolone_Improves_Recovery_of.2.aspx
Background: The visual outcome in untreated nonarteritic anterior ischemic optic neuropathy (NAION) is dismal. Because intravitreal triamcinolone (IVTA) has shown promise in improving edematous retinal disorders, a pilot trial of this therapy in NAION was considered reasonable.
Methods: Four eyes of 4 patients with severe visual loss due to NAION were treated with 4 mg IVTA (study group). The control group consisted of 6 consecutive patients with NAION who received no treatment. Patients were evaluated by the visual acuity and visual field measurements of the Early Treatment Diabetic Retinopathy Study (ETDRS) and fluorescein angiography.
Results: All patients completed at least 9 months of follow-up. In the study group, the mean improvement in visual acuity were 4, 5.8, and 6.2 ETDRS lines at the first and third weeks and final visit, respectively. Optic disc swelling and leakage had markedly decreased at the first postinjection week and had disappeared by the third week examination in all eyes. In the control group, the mean improvements in visual acuity were 0, 0.7, and 1.3 ETDRS lines at the first and third weeks and final visit, respectively. Control eyes showed resolution of the optic disc swelling between the fourth week and third month visits. No marked change in visual field defects was observed in either group.
Conclusions: IVTA provided relatively improved recovery of visual acuity and relatively rapid resolution of optic disc swelling in a small sample of patients with acute NAION. It did not provide visual field improvement. A larger trial is merited by the results of this small pilot study.]]>Wed, 08 Jun 2011 11:24:55 GMT-05:0000041327-200709000-00002http://journals.lww.com/jneuro-ophthalmology/Fulltext/2007/09000/Intravitreal_Triamcinolone_or_Bevacizumab_for.1.aspx
No abstract available]]>Wed, 08 Jun 2011 12:17:42 GMT-05:0000041327-200709000-00001http://journals.lww.com/jneuro-ophthalmology/Fulltext/2008/03000/Intravitreal_Triamcinolone_for_Nonarteritic.18.aspx
No abstract available]]>Wed, 08 Jun 2011 12:20:47 GMT-05:0000041327-200803000-00018http://journals.lww.com/jneuro-ophthalmology/Fulltext/2007/09000/Treatment_of_Nonarteritic_Anterior_Ischemic_Optic.13.aspx
No abstract available]]>Wed, 08 Jun 2011 12:21:50 GMT-05:0000041327-200709000-00013http://journals.lww.com/jneuro-ophthalmology/Fulltext/2009/06000/Anterior_Ischemic_Optic_Neuropathy_After.18.aspx
No abstract available]]>Wed, 08 Jun 2011 12:22:56 GMT-05:0000041327-200906000-00018http://pdfs.journals.lww.com/jneuro-ophthalmology/1997/03000/Asymptomatic_Optic_Disc_Edema_.5.pdf
Non-arteritic anterior ischemic optic neuropathy (AION-na) classically presents with visual loss, altitudinal visual field defects, and optic nerve swelling. AION-na presumably occurs secondary to an ischemic event. Two patients are described who were at risk for developing AION-na. Both patients presented with optic disc edema but did not have visual loss or visual field defects. Neither patient developed visual loss or visual field defects in the affected eye throughout one and two years of follow-up respectively. The optic disc edema resolved spontaneously in both affected eyes. The clinical spectrum of AION-na could range from a "full-blown" classic attack to a minimal attack characterized by disc swelling without visual loss. The amount and distribution of disc ischemia determines the individual clinical picture. The failure of either affected eye in this study to develop symptoms likely represents a graded axonal atrophy with mechanical decompression of the optic nerve.
(C) Williams & Wilkins 1997. All Rights Reserved.]]>Wed, 08 Jun 2011 12:23:59 GMT-05:0000041327-199703000-00005http://journals.lww.com/jneuro-ophthalmology/Fulltext/2002/06000/Prolonged_Premonitory_Optic_Disc_Signs_In_Anterior.10.aspx
A patient displayed a pink mass on the right optic disc and normal visual function that was diagnosed as a capillary hemangioma. Seven months later, he developed typical features of nonarteritic anterior ischemic optic neuropathy (NAION) in that eye. Such a long latency between “preeruptive” and “eruptive” disc edema has not been well documented in NAION.]]>Wed, 08 Jun 2011 12:25:13 GMT-05:0000041327-200206000-00010http://journals.lww.com/jneuro-ophthalmology/Fulltext/2003/09000/Visual_Outcome_in_Eyes_With_Asymptomatic_Optic.4.aspx
Background: Asymptomatic optic disc edema may last for months before conversion to anterior ischemic optic neuropathy (AION). Alternatively, the optic disc edema may resolve with preservation of normal vision. The conversion rate of asymptomatic optic disc edema to AION has not been prospectively studied. We prospectively followed patients with asymptomatic disc edema to determine this conversion rate.
Methods: The cohort was followed from 1991 to 2000 at a single ophthalmology clinic in Israel. There were 23 patients aged 47–74 years with asymptomatic disc edema and no signs of optic nerve dysfunction in whom the disc edema had been incidentally discovered on routine fundus examination performed for diabetes, hypertension, or follow-up after AION in the fellow eye.
Results: In 9 (36%) eyes, optic disc edema progressed to overt AION with a mean latency of 16.8 weeks (range 2–80 weeks). In 16 (64%) eyes, optic disc edema resolved without loss of vision with a mean latency of 15.5 weeks (range 4–44 weeks). The conversion rate to AION was 40% in patients who had had AION in the fellow eye, 31% in patients with diabetes, 43% in patients with diabetic retinopathy, and 0% in four amiodarone-treated patients.
Conclusion: Asymptomatic disc edema generally resolves with no visual loss, but one third of patients progress to full-blown AION. Diabetes mellitus is common in patients with asymptomatic optic disc edema. Perhaps patients diagnosed as having diabetic papillopathy actually have an impending AION that does not progress to overt disease.
Patients with anterior ischemic optic neuropathy (AION) always manifest optic disc edema when presenting to the ophthalmologist with visual loss. In 1981, Hayreh (1). first described 4 visually asymptomatic patients in whom disc edema was diagnosed on a routine examination. Some of these patients, who had normal visual function, later developed typical symptomatic AION. Other patients have asymptomatic optic disc edema that resolves spontaneously. This phenomenon has been described mainly in diabetes mellitus (2) and has therefore been called “diabetic papillopathy.” There is much confusion as to whether diabetic papillopathy and AION are the same entities. In 1997, Gordon et al (3) described 2 patients who had AION in 1 eye and asymptomatic optic disc edema in the fellow eye that resolved spontaneously. Spontaneous resolution of asymptomatic optic disc edema has also been described in patients treated with amiodarone (4,5).
The conversion rate of asymptomatic optic disc edema to symptomatic AION has never been prospectively studied. It was the purpose of this study to determine this rate and to characterize the patients who undergo conversion.]]>Wed, 08 Jun 2011 12:25:51 GMT-05:0000041327-200309000-00004http://journals.lww.com/jneuro-ophthalmology/Fulltext/2008/03000/Reply_.21.aspx
No abstract available]]>Wed, 08 Jun 2011 12:27:38 GMT-05:0000041327-200803000-00021http://journals.lww.com/jneuro-ophthalmology/Fulltext/2008/03000/Animal_Model_for_Nonarteritic_Anterior_Ischemic.20.aspx
No abstract available]]>Wed, 08 Jun 2011 12:28:02 GMT-05:0000041327-200803000-00020http://journals.lww.com/jneuro-ophthalmology/Fulltext/2011/06000/Current_Concepts_in_the_Diagnosis,_Pathogenesis,.27.aspx
No abstract available]]>Wed, 08 Jun 2011 12:29:57 GMT-05:0000041327-201106000-00027